[Hematological and iron parameters to predict mortality in ESRD]

The prognostic value of hematological parameters other than hemoglobin (Hb) has been seldom investigated in hemodialysis (HD) patients. We used the predialytic assessment of blood ferritin, blood transferrin, transferrin saturation, blood iron, total iron binding capacity (TIBC), Hb, reticulocyte count, IRF, mean corpuscular volume (MCV), RDW, CHR, in our HD patients, as well as the weekly iron and erythropoietin (EPO) supplementation, to evaluate the relationship with death in the subsequent 12-month period. Data were divided into two groups (group M for dead patients and group V for patients remaining alive after 12 months) and mean +/- SD with significant differences (Student's t-test) were calculated. The following results were obtained: blood transferrin: M (n=21) 1.78 +/- 0.57, V (n=96) 1.72 +/- 0.36 g/L (p=ns); blood iron: M (n=22) 8.66 +/- 5.07, V (n=97) 10.50 +/- 4.57 mmol/L (p=ns); TIBC: M (n=21) 42.69 +/- 13.63, V (n=98) 40.36 +/- 10.33 mmol of iron/L (p=ns); transferrin saturation: M (n=21) 22.10 +/- 13.07, V (n=96) 25.81 +/- 11.79% (p=ns); blood Hb: M (n=22) 107.55 +/-19.70, V (n=98) 111.02 +/- 14.68 g/L (p=ns); MCV: M (n=22) 94.58 +/- 7.35, V (n=98) 93.27 +/- 8.16 fL (p=ns); RDW: M (n=22) 16.60 +/- 1.51, V (n=98) 15.83 +/- 1.39 (p<0.022); soluble transferrin receptors: M (n=18) 1.85 +/- 0.90, V (n=90) 1.89 +/- 0.75 mg/L (p=ns); reticulocyte count: M (n=22) 91.38 +/- 34.69, V (n=98) 87.27 +/- 29.56 *10 9 /L (p=ns); CHR: M (n=22) 31.36 +/- 2.92, V (n=98) 31.46 +/- 3.08 pg (p=ns); IRF: M (n=22) 24.81 +/- 7.55, V (n=98) 23.65 +/- 8.64 (p=ns); intravenous Fe+++ weekly supplementation: M (n=22) 45.45 +/- 26.81, V (n=98) 37.31 +/- 32.25 mg/week (p=ns); a-EPO weekly supple-mentation: M (n=22) 9090.91 +/- 7824.92, V (n=97) 9030.93 +/- 8292.13 UI/week (p=ns). Since it was not feasible to compare an individual event such as death with the spectra of laboratory data or the administered drug amount, the values of each series were in descending order and the number of M patients (approximately 20% of the total) falling into the upper or lower 20% of values was calculated. In front to the expected amount of 4.4 M for each 20%, two M patients fell into the upper 20% and six patients into the lower 20% of blood ferritin values, and, correspondingly, two vs. nine patients for blood iron, four vs. seven patients for transferrin saturation, three vs. seven patients for blood Hb, eight vs. two patients for RDW and six vs. two patients for iron supplementation. Therefore, our patients with a negative prognosis showed an increase in RDW and an iron availability or metabolism disorder.